Experienced advanced practice providers (APPs), inclusive of advanced practice nurses and physician assistants, are a growing sector of transformational leaders ensuring healthcare access.1,2 Formalized training to develop administrative and leadership skills is a necessary foundation for APP leaders.1 One training opportunity for APPs who are interested in formal leadership positions is an APP fellowship in administration. An APP fellowship with a focus in administration offers clinically expert APPs, who aspire to hold leadership positions, an opportunity to receive specialized training and guided practice to successfully transition to formal leadership roles.

In 2016, Stanford Health Care Center for Advanced Practice initiated the APP Fellowship Program for select clinical specialties including cancer, cardiothoracic surgery, and electrophysiology. In 2018, APP leaders of the APP Fellowship Program used the American Nurses Credentialing Center (ANCC) Practice Transition Accreditation Program (PTAP) criteria3 to design a curriculum based on professional leader competencies to provide a transition-to-practice opportunity for experienced APPs who desired a career focus in administration. The APP Fellowship Program domains of transition to practice, professionalism, and acquisition of specialty knowledge are applied to the administration specialty.

The APP Fellowship Program

Each year, 1 APP fellow is hired for the administration specialty, as a full-time, benefited employee. The APP fellow in administration (ADM APP fellow) is required to have greater than 5 years of clinical experience and an identified goal of a formal leadership position in the future. Candidates include APPs employed internal and external to Stanford Health Care. No business or administration training or experience is required. During the 12-month fellowship, the ADM APP fellow focuses on operational management inclusive of human resource management, technology systems, outcomes, and metrics; professional role and accountability, emotional intelligence, and effective communication and leadership development; and strategic planning, decision making, and leading high-performing teams. The curriculum is outlined in SDC #1, available at http://links.lww.com/JONA/B2.

Training methods include didactic and practice-based learning. The didactic component is composed of organizational leader training including an authentic leadership project, interprofessional clinical effectiveness team training with a project, and Lean Six Sigma green belt certification. The ADM APP fellow participates in professional development activities with the clinical APP fellows-as an activity leader. Activities include quality and process improvement training, structured cohort-based mentorship, interprofessional communication, and facilitation of a journal club. Relevant competencies are selected from leadership organizations such as the American College of Health Care Executives,4 American Organization of Nurse Executives: Nurse Executive Competencies,5 and American Organization of Nurse Executives: Nurse Manager Competencies.6

Practice-based learning occurs with APP leaders in the nonclinical setting with a focus on process and people management. The ADM APP fellow trains with the APP leaders in the Center for Advanced Practice to progressively lead monthly APP onboarding and weekly APP workforce planning meetings, guide a shared leadership committee, conduct a quality improvement project, and strategically plan for a legislative change process.

People management is practiced by managing 4 clinical APP fellows for 6 months as their direct supervisor, and participating in the interviewing, hiring, and credentialing of the subsequent cohort of fellows. Situations requiring performance improvement are practiced with high-fidelity simulation and, if necessary, are delivered by the ADM APP fellow to the designated clinical APP fellow.

Outcomes

Stanford Health Care APP Fellowship Program received reaccreditation with distinction in April 2022 from the ANCC. The accreditation is evidence that the ADM APP fellowship meets the rigor of the ANCC standards for transition-to-practice programs.3

The administration specialty has enhanced the identity of the APP fellowship beyond clinical roles and added visibility and credibility of APP leadership within the organization. Administration APP fellows contribute to organizational strategies such as Magnet certification. Fellows participate in the design of new care models like the 1st APP team for the medical ICU, contribute to APP workforce planning, organize an APP leader retreat, and develop the leadership curriculum and rotation for students of the affiliated Master of Science Physician Assistant program. ADM APP fellows share their work through professional presentations and publications.7 The ADM APP fellow graduates work in nursing or APP leadership roles. The professional outcomes of the ADM APP fellow graduates are outlined in case studies (SDC #2, http://links.lww.com/JONA/B3).

Conclusion

With APPs as a growing sector of healthcare leaders, the training of APP leaders is evolving and necessary. The ANCC PTAP structure is one way to successfully train experienced APPs to transition from clinical practice to administration and continue to build a future of advanced practice leadership.

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